U.S. patent application number 13/673148 was filed with the patent office on 2014-05-15 for recessed groove for better suture retention.
This patent application is currently assigned to COVIDIEN LP. The applicant listed for this patent is COVIDIEN LP. Invention is credited to Michael J. Bettuchi.
Application Number | 20140131419 13/673148 |
Document ID | / |
Family ID | 49584596 |
Filed Date | 2014-05-15 |
United States Patent
Application |
20140131419 |
Kind Code |
A1 |
Bettuchi; Michael J. |
May 15, 2014 |
Recessed Groove for Better Suture Retention
Abstract
An end effector for use with a surgical stapler. The end
effector comprising a staple cartridge having a tissue contacting
surface having at least one recessed groove defined therein and an
anvil plate having a tissue contacting surface having at least one
recessed groove defined therein. A surgical buttress releasably
disposed on the tissue contacting surfaces of each of the staple
cartridge and the anvil plate. At least one suture is disposed
within the at least one recessed groove of each of the staple
cartridge and anvil plate and configured to retain the respective
surgical buttress atop the respective tissue contacting
surface.
Inventors: |
Bettuchi; Michael J.;
(Middletown, CT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
COVIDIEN LP |
Mansfield |
MA |
US |
|
|
Assignee: |
COVIDIEN LP
Mansfield
MA
|
Family ID: |
49584596 |
Appl. No.: |
13/673148 |
Filed: |
November 9, 2012 |
Current U.S.
Class: |
227/176.1 |
Current CPC
Class: |
A61B 17/07292 20130101;
A61B 2017/07257 20130101; A61B 17/1155 20130101; A61B 2017/07271
20130101 |
Class at
Publication: |
227/176.1 |
International
Class: |
A61B 17/068 20060101
A61B017/068 |
Claims
1. An end effector for use with a surgical stapler, the end
effector comprising: a staple cartridge having a tissue contacting
surface having at least one recessed groove defined therein; an
anvil plate having a tissue contacting surface having at least one
recessed groove defined therein; a surgical buttress releasably
disposed on the tissue contacting surfaces of each of the staple
cartridge and the anvil plate; and at least one suture disposed
within the at least one recessed groove of each of the staple
cartridge and anvil plate and configured to retain the respective
surgical buttress atop the respective tissue contacting
surface.
2. The end effector of claim 1, wherein the at least one recessed
groove of the staple cartridge extends from a first outer side edge
to a second outer side edge of the staple cartridge, and the at
least one recessed groove of the anvil plate extends from a first
outer side edge to a second outer side edge of the anvil plate.
3. The end effector of claim 2, wherein a proximal recessed groove
is positioned along a proximal portion of each of the staple
cartridge and anvil plate, and a distal recessed groove is defined
along a distal portion of each of the staple cartridge and the
anvil plate.
4. The end effector of claim 3, wherein the staple cartridge and
the anvil plate have a central longitudinal slot configured to
enable a passage of a knife blade therethrough.
5. The end effector of claim 4, wherein the proximal recessed
groove is positioned distally from a proximal end of the central
longitudinal slot on each of the staple cartridge and anvil
plate.
6. The end effector of claim 5, wherein the distal recessed groove
is positioned proximally from a distal end of the central
longitudinal slot on each of the staple cartridge and anvil
plate.
7. The end effector of claim 5, wherein the distal recessed groove
is positioned distally from a distal end of the central
longitudinal slot on each of the staple cartridge and anvil
plate.
8. A staple cartridge for use with a surgical stapling apparatus,
the staple cartridge comprising: a cartridge body including a
tissue contacting surface defining a plurality of staple retaining
slots and having at least one recessed groove defined therein; a
staple disposed within each staple retaining slot of the cartridge
body; a surgical buttress configured and dimensioned to
substantially overlie at least a portion of the staple retaining
slots of the cartridge body; and at least one suture disposed
within the at least one recessed groove of the cartridge body and
configured to retain the surgical buttress atop the tissue
contacting surface.
9. The staple cartridge claim 8, wherein the at least one recessed
groove extends from a first outer side edge to a second outer side
edge of the staple cartridge.
10. The staple cartridge of claim 9, wherein a proximal recessed
groove is positioned along a proximal portion of each of the staple
cartridge and a distal recessed groove is positioned along a distal
portion of each of the staple cartridge.
11. The staple cartridge of claim 10, wherein the staple cartridge
has a central longitudinal slot configured to enable a passage of a
knife blade therethrough.
12. The staple cartridge of claim 11, wherein the proximal recessed
groove is positioned distally from a proximal end of the central
longitudinal slot on the staple cartridge.
13. The staple cartridge of claim 12, wherein the distal recessed
groove is positioned proximally from a distal end of the central
longitudinal slot on the staple cartridge.
14. A surgical stapling apparatus, comprising: a housing; an end
effector being secured to the housing having a staple cartridge
assembly having a tissue contacting surface and an anvil assembly
having a tissue contacting surface, each of the tissue contacting
surfaces of the staple cartridge assembly and the anvil assembly
having at least one transversely extending recessed groove; a
surgical buttress configured and dimensioned to substantially
overlie at least a portion of the tissue contacting surface of at
least one of the staple cartridge assembly and anvil assembly; and
a suture disposed within the at least one recessed groove of each
of the tissue contacting surfaces of the staple cartridge assembly
and the anvil plate and configured to retain the respective
surgical buttress atop the respective tissue contacting
surface.
15. The surgical stapling apparatus of claim 14, wherein a proximal
recessed groove is positioned along a proximal portion of each of
the staple cartridge and anvil plate, and a distal recessed groove
is positioned along a distal portion of each of the staple
cartridge and the anvil plate.
Description
BACKGROUND
[0001] 1. Technical Field
[0002] The present disclosure relates to surgical stapling
apparatus including surgical buttresses which can be releasably
attached to the surgical stapling apparatus, and in particular, to
surgical stapling apparatus having sutures disposed within recessed
grooves therein. Sutures join the surgical buttress to the surgical
stapling apparatus such that the surgical buttress is released upon
firing of the surgical stapling apparatus.
[0003] 2. Background of Related Art
[0004] Surgical stapling instruments that are used to sequentially
or simultaneously apply one or more rows of fasteners to join
segments of body tissues are well known in the art. The fasteners
are typically in the form of surgical staples but two part
polymeric fasteners can also be utilized. Such devices generally
include a pair of jaws to clamp therebetween the body tissues to be
joined. Typically, one of the jaw members includes a staple
cartridge which accommodates a plurality of staples arranged in at
least two lateral rows while the other jaw member has an anvil
plate that defines a surface for forming the staple legs as the
staples are driven from the staple cartridge.
[0005] When the stapling instrument is actuated, longitudinally
translating cams contact staple drive members in one of the jaws
which in turn acts upon staple pushers to sequentially or
simultaneously eject the staples from the staple cartridge. A blade
can travel between the staple rows to longitudinally cut and/or
open the stapled tissue between the rows of staples. Such
instruments are disclosed, for example, in U.S. Pat. No. 3,079,606
and U.S. Pat. No. 3,490,675, the disclosures of which are hereby
incorporated by reference in their entirety.
[0006] When stapling relatively thin or fragile tissues, it is
important to effectively seal the staple line against air or fluid
leakage. Additionally, it is often necessary to reinforce the
staple line against the tissue to prevent tears in the tissue or
pulling of the staples through the tissue. One method of preventing
tears or pull through involves the placement of a biocompatible
fabric reinforcing material, or a "surgical buttress," between the
staple and the underlying tissue. In this method, a layer of
surgical buttress is placed against the tissue and the tissue is
stapled in a conventional manner through the surgical buttress. In
more recent methods, the layer of surgical buttress is positioned
on the stapling instrument itself prior to stapling the tissue.
Some surgical staplers utilize fasteners or clips to temporarily
connect surgical buttresses to each of the jaws of the staplers,
i.e., one disposed on the staple cartridge and the other on the
anvil plate.
[0007] The present application discloses a retention system for
securing surgical buttresses to the jaws of the stapler. The
retention system allows the surgical buttresses to secure to a
tissue contacting surface of the staple cartridge and anvil plate
by utilizing sutures disposed within recessed grooves along the
tissue contacting surfaces of each of the staple cartridge and
anvil plate. This retention system diminishes the likelihood of
premature suture release during assembly, packing or firing.
SUMMARY
[0008] According to one aspect of the present disclosure, an end
effector for use with a surgical stapler comprising a staple
cartridge having a tissue contacting surface having at least one
recessed groove defined therein and an anvil plate having a tissue
contacting surface having at least one recessed groove defined
therein. A surgical buttress releasably disposed on the tissue
contacting surfaces of each of the staple cartridge and the anvil
plate. At least one suture is disposed within the at least one
recessed groove of each of the staple cartridge and anvil plate and
configured to retain the respective surgical buttress atop the
respective tissue contacting surface. Preferably, the at least one
recessed groove of the staple cartridge extends from a first outer
side edge to a second outer side edge of the staple cartridge and
the at least one recessed groove of the anvil plate extends from a
first outer side edge to a second outer side edge of the anvil
plate. A proximal recessed groove is positioned along a proximal
portion of each of the staple cartridge and anvil plate and a
distal recessed groove is positioned along a distal portion of each
of the staple cartridge and the anvil plate.
[0009] The staple cartridge and the anvil plate each have a central
longitudinal slot configured to enable a passage of a knife blade
therethrough. The proximal recessed groove is positioned distally
from a proximal end of the central longitudinal slot on each of the
staple cartridge and anvil plate. The distal recessed groove is
positioned proximally from a distal end of the central longitudinal
slot on each of the staple cartridge and anvil plate.
[0010] In alternate embodiments, the distal recessed groove is
positioned distally from a distal end of the central longitudinal
slot on each of the staple cartridge and anvil plate.
[0011] In another aspect of the present disclosure, a staple
cartridge for use with a surgical stapling apparatus comprising a
cartridge body including a tissue contacting surface defining a
plurality of staple retaining slots and having at least one
recessed groove defined therein wherein a staple is disposed within
each staple retaining slot of the cartridge body. A surgical
buttress configured and dimensioned to substantially overlie at
least a portion of the staple retaining slots of the cartridge body
and at least one suture is disposed within the at least one
recessed groove of the cartridge body and configured to retain the
surgical buttress atop the tissue contacting surface. Preferably,
the at least one recessed groove extends from a first outer side
edge to a second outer side edge of the staple cartridge.
[0012] In embodiments, a proximal recessed groove is positioned
along a proximal portion of each of the staple cartridge and a
distal recessed groove is positioned along a distal portion of each
of the staple cartridge. The staple cartridge has a central
longitudinal slot configured to enable a passage of a knife blade
therethrough. The proximal recessed groove is positioned distally
from a proximal end of the central longitudinal slot on the staple
cartridge. The distal recessed groove is positioned proximally from
a distal end of the central longitudinal slot on the staple
cartridge.
[0013] In yet another aspect of the present disclosure, a surgical
stapling apparatus, comprising a housing and an end effector being
secured to the housing having a staple cartridge assembly having a
tissue contacting surface and an anvil assembly having a tissue
contacting surface, each of the tissue contacting surfaces of the
staple cartridge assembly and the anvil assembly having at least
one transversely extending recessed groove. A surgical buttress
configured and dimensioned to substantially overlie at least a
portion of the tissue contacting surface of at least one of the
staple cartridge assembly and anvil assembly. A suture is disposed
within the at least one recessed groove of each of the tissue
contacting surfaces of the staple cartridge assembly and the anvil
plate and configured to retain the respective surgical buttress
atop the respective tissue contacting surface. Preferably, a
proximal recessed groove is positioned along a proximal portion of
each of the staple cartridge and anvil plate, and a distal recessed
groove is positioned along a distal portion of each of the staple
cartridge and the anvil plate.
BRIEF DESCRIPTION OF THE DRAWINGS
[0014] Various embodiments of the presently disclosed retention
systems are disclosed herein with reference to the drawings,
wherein:
[0015] FIG. 1 is a perspective view of a surgical stapling
apparatus according to an embodiment of the present disclosure;
[0016] FIG. 2 is a perspective view, with parts separated, of a
staple cartridge assembly of the surgical stapling apparatus of
FIG. 1, illustrating a surgical buttress associated therewith;
[0017] FIG. 3 is a perspective view, with parts separated, of an
anvil assembly of the surgical stapling apparatus of FIG. 1,
illustrating a surgical buttress associated therewith;
[0018] FIG. 4 is a perspective view of the staple cartridge
assembly, illustrating the surgical buttress affixed to the staple
cartridge of FIG. 2;
[0019] FIG. 5 is a perspective view of the anvil assembly,
illustrating the surgical buttress affixed to the anvil plate of
FIG. 3;
[0020] FIG. 6 is a perspective view of a distal end of the surgical
stapling apparatus of FIG. 1, shown in use positioned about a
tissue section;
[0021] FIG. 7 is a cross-sectional view taken along line 7-7 of
FIG. 6;
[0022] FIG. 7A is an enlarged area of detail depicted in FIG.
7;
[0023] FIG. 8 is a perspective view of the stapled and divided
tissue section of FIG. 6;
[0024] FIG. 9A is a perspective view of an illustrative embodiment
of a surgical stapling apparatus in accordance with another
embodiment of the present disclosure;
[0025] FIG. 9B is a side elevational view partially, broken away,
of the surgical stapling apparatus of FIG. 9A;
[0026] FIG. 10A is a perspective view of an illustrative embodiment
of the staple cartridge assembly of the surgical stapling apparatus
of FIG. 9A including a surgical buttress in accordance with an
embodiment of the present disclosure;
[0027] FIG. 10B is a top plan view of the staple cartridge assembly
and surgical buttress illustrated in FIG. 10A;
[0028] FIG. 11 is perspective view of an intestinal area of a
patient, illustrating a method of positioning an anvil rod and
staple cartridge assembly of the surgical stapling apparatus of
FIGS. 9A, 9B, and 10 within the intestinal area; and
[0029] FIG. 12 is a schematic perspective view of the intestinal
area of FIG. 11, illustrating the anvil rod mounted to the surgical
stapling apparatus.
DETAILED DESCRIPTION OF THE EMBODIMENTS
[0030] Various exemplary embodiments of the present disclosure are
discussed herein below in terms of surgical buttresses for use with
surgical stapling apparatus. The surgical buttresses described
herein may be used in sealing a wound by approximating the edges of
wound tissue between a staple cartridge and an anvil plate of a
surgical stapling apparatus which contains at least one surgical
buttress. The at least one surgical buttress is joined to the
surgical stapling apparatus by at least one suture disposed within
a recessed groove of a tissue contacting surface of each of a
staple cartridge and anvil plate. Firing of the surgical stapling
apparatus forces legs of at least one staple to pass through an
opening on the staple cartridge, the tissue, and the openings on
the anvil plate to secure the surgical buttress to the tissue, to
secure the adjoining tissue to one another, and to seal the tissue.
The firing force of the staple impacts the suture to release the
suture from the recessed groove thereby releasing the surgical
buttress from the tissue contacting surface. Thus, the present
disclosure describes surgical buttresses, surgical stapling
apparatus supporting said surgical buttresses, and methods and
mechanisms for using the same.
[0031] It should be understood that a variety of surgical stapling
apparatus may be utilized with a surgical buttress of the present
disclosure. For example, linear stapler configurations may be
utilized, such as, for example those including Duet TRS.TM. reloads
and staplers with Tri-Staple.TM. technology, available through
Covidien, which maintain a principal place of business at 555 Long
Wharf Drive, North Haven, Conn. 06511, and transverse anastomosis
staplers, such as, for example, EEA.TM., CEEA.TM., GIA.TM.,
EndoGIA.TM., and TA.TM., also available through Covidien. It should
also be appreciated that the principles of the present disclosure
are equally applicable to surgical staplers having alternate
configurations, such as, for example, end-to-end anastomosis
staplers having a circular cartridge and anvil (see, e.g., commonly
owned U.S. Pat. No. 5,915,616, entitled "Surgical Fastener Applying
Apparatus," the entire content of which is incorporated herein by
this reference); laparoscopic staplers (see, e.g., commonly owned
U.S. Pat. Nos. 6,330,965 and 6,241,139, each entitled "Surgical
Stapling Apparatus," the entire contents of each of which being
incorporated herein by this reference); and transverse anastomosis
staplers (see, e.g., commonly owned U.S. Pat. Nos. 5,964,394 and
7,334,717, each entitled "Surgical Fastener Applying Apparatus",
the entire contents of each of which being incorporated herein by
this reference).
[0032] Embodiments of the presently disclosed surgical buttress and
surgical stapling apparatus will now be described in detail with
reference to the drawing figures wherein like reference numerals
identify similar or identical elements. In the following
discussion, the terms "proximal" and "trailing" may be employed
interchangeably, and should be understood as referring to the
portion of a structure that is closer to a clinician during proper
use. The terms "distal" and "leading" may also be employed
interchangeably, and should be understood as referring to the
portion of a structure that is further from the clinician during
proper use. As used herein, the term "patient" should be understood
as referring to a human subject or other animal, and the term
"clinician" should be understood as referring to a doctor, nurse,
or other care provider and may include support personnel.
[0033] Referring now to FIG. 1, there is disclosed an exemplary
surgical stapling apparatus or surgical stapler 10 for use in
stapling tissue and applying a buttress material or surgical
buttress to the tissue. A redundant example of this type of
surgical stapling instrument is disclosed in U.S. Pat. No.
7,128,253, the entire disclosure of which is incorporated by
reference herein.
[0034] Surgical stapling apparatus 10 generally includes a handle
12 having an elongate tubular member 14 extending distally from
handle 12. An end effector assembly 16 is mounted on a distal end
18 of elongate tubular member 14. End effector assembly 16 includes
a first jaw or staple cartridge assembly 200 configured to receive
a staple cartridge 32 therein and a second jaw or anvil assembly
300. End effector assembly 16 may be permanently affixed to
elongate tubular member 14 or may be detachable and thus
replaceable with a new end effector assembly 16. One of staple
cartridge assembly 200 and anvil assembly 300 is movably mounted at
distal end 18 of end effector assembly 16, and is movable between
an open position spaced apart from one another to a closed position
substantially adjacent to one another. Anvil assembly 300 supports
an anvil plate 302 and is fabricated from a metal material,
including and not limited to stainless steel, titanium, titanium
alloy, and the like. At least a tissue contacting surface of staple
cartridge 32 is fabricated from a material other than metal,
including and not limited to plastic, thermoplastic, resin,
polycarbonate, and the like.
[0035] Surgical stapling apparatus 10 further includes a trigger
33, as seen in FIG. 1, movably mounted on handle 12. Actuation of
trigger 33 initially operates to move first jaw and second jaw
between the open and the closed positions and simultaneously
actuates surgical stapling apparatus 10 to apply lines of staples
to tissue. In order to properly orient end effector assembly 16
relative to the tissue to be stapled, surgical stapling apparatus
10 is additionally provided with a rotation knob 34 mounted on
handle 12. Rotation of rotation knob 34 relative to handle 12
rotates elongate tubular member 14 and end effector assembly 16
relative to handle 12 so as to properly orient end effector
assembly 16 relative to the tissue to be stapled.
[0036] A driver 36, as seen in FIGS. 6 and 7A, is provided to move
approximate first jaw or staple cartridge assembly 200 and second
jaw or anvil assembly 300 from the open position to the closed
position. Driver 36 moves through a longitudinal slot 338 (FIG. 3)
formed in the anvil plate 302 of anvil assembly 300. A knife 30
with knife blade 31 is associated with driver 36 to cut tissue
captured between staple cartridge assembly 200 and anvil assembly
300 as driver 36 passes through slot 338.
[0037] Reference may be made to commonly owned U.S. Pat. Nos.
5,915,616, 6,330,965, and 6,241,139, referenced above, the entire
contents of each of which being incorporated herein by reference
for a detailed discussion of the construction and operation of an
exemplary surgical stapling apparatus 10.
[0038] Staple cartridge assembly 200 and/or anvil assembly 300 may
be provided with a surgical buttress 500. Surgical buttress 500 is
provided to reinforce and seal the lines of staples applied to
tissue by surgical stapling apparatus 10. Surgical buttress 500 may
be configured into any shape, size, or dimension suitable to fit
any surgical stapling, fastening, or firing apparatus.
[0039] Staple cartridge assembly 200 is provided with a cartridge
buttress 500a and anvil assembly 300 is provided with an anvil
buttress 500b in the manners described in more detail hereinbelow.
The surgical buttresses 500a, 500b may be made from any
biocompatible natural or synthetic material. The material from
which the surgical buttresses 500a, 500b are formed may be
bioabsorbable or non-bioabsorbable. It should be understood that
any combination of natural, synthetic, bioabsorbable and
non-bioabsorbable materials may be used to form the buttress
material. The surgical buttresses 500a, 500b may be porous or
non-porous, combination of porous and non-porous layers. The
non-porous surgical buttresses 500a, 500b may be utilized to retard
or prevent tissue ingrowth from surrounding tissues thereby acting
as an adhesion barrier and preventing the formation of unwanted
scar tissue.
[0040] Additional exemplary materials for surgical buttresses 500a,
500b for use with the surgical stapling devices disclosed herein
are set forth in commonly assigned U.S. Pat. Nos. 5,542,594;
5,908,427; 5,964,774; and 6,045,560, and commonly assigned U.S.
Application Publication Nos. 2006/0085034, filed on Apr. 20, 2006;
and 2006/0135992, filed on Jun. 22, 2006, the entire contents of
each of which is incorporated herein by reference.
[0041] As illustrated in the current embodiment and shown in FIGS.
2 and 3, surgical buttress 500 is releasably attached to staple
cartridge assembly 200 and/or anvil assembly 300 by a buttress
retention system 230, 330 including sutures 240, 340 that affix
surgical buttresses 500a, 500b to the inwardly facing or tissue
contacting surfaces 220, 320 of the staple cartridge 32 and/or the
anvil plate 302, as discussed in detail below.
[0042] With reference to FIGS. 2 and 4, cartridge buttress 500a of
staple cartridge assembly 200 is operatively secured to a tissue
contacting surface 220 of staple cartridge 32 by cartridge buttress
retention system 230 including sutures 240 positioned within
recessed grooves 250. The cartridge buttress 500a is disposed
between the suture 240 and the tissue contacting surface 220.
Staple cartridge assembly 200 further includes a first outer edge
248a and second outer edge 248b. As shown in FIG. 2, recessed
groove 250 extends from the first outer edge 248a to the second
outer edge 248b such that recessed groove 250 passes transversely
across the tissue contacting surface 220. Preferably, a proximal
recessed groove 250a is disposed along a proximal portion 260 of
the tissue contacting surface 220. Similarly, a distal recessed
groove 250b is disposed along a distal portion 262 of tissue
contacting surface 220. Proximal suture 240a is disposed within the
proximal recessed groove 250a and passes transversely across
cartridge buttress 500a and the proximal portion 260 of tissue
contacting surface 220 of staple cartridge 32. In the same manner,
distal suture 240b disposed within the distal recessed groove 250b
and passes transversely across cartridge buttress 500b and the
distal portion of tissue contacting surface 220 of staple cartridge
32. The proximal and distal sutures 240a, 240b disposed within the
respective proximal and distal recessed grooves 250a, 250b maintain
the cartridge buttress 500b securely along the tissue contacting
surface 220 of staple cartridge 32 prior to firing of the stapler
10.
[0043] With reference to FIGS. 3 and 5, and similar to cartridge
buttress 500a, anvil buttress 500b is operatively secured to a
tissue contacting surface 320 of anvil plate 302 by an anvil
buttress retention system 330 including sutures 340 positioned
within recessed grooves 350a, 350b onto both a proximal end 360 and
a distal end 362, respectively, of the tissue contacting surface
320. Proximal suture 340a is disposed within the proximal recessed
groove 350a and passes transversely across anvil buttress 500b and
the proximal portion 360 of tissue contacting surface 320 of anvil
plate 302 from a third outer edge 348a to a forth outer edge 348b.
In the same manner, distal suture 340b is disposed within the
distal recessed groove 350b and passes transversely across anvil
buttress 500b and the distal portion of tissue contacting surface
320 of anvil plate 302 from a third outer edge 348a to a forth
outer edge 348b.
[0044] In embodiments, it is contemplated that recessed grooves
250, 350 may be disposed in varying positions along tissue
contacting surfaces 220, 320 relative to central longitudinal slots
238, 338 of staple cartridge 32 and anvil plate 320. More
specifically, as shown in FIG. 2, proximal recessed groove 250a is
disposed distally of a proximal end of the central longitudinal
slot 238 of staple cartridge 32. Distal recessed groove 250b is
disposed proximally of a distal end of central longitudinal slot
238. Similarly, as shown in FIG. 3, proximal recessed groove 350a
of anvil plate 320 is disposed distally of a proximal end of
central longitudinal slot 338 and distal recessed groove 350b is
disposed proximally of a distal end of central longitudinal slot
338. In this embodiment, when knife blade 31 is actuated to cut
tissue captured between staple cartridge assembly 200 and anvil
assembly 300, knife blade 31 also severs sutures 240, 340.
[0045] FIGS. 4 and 5 illustrate the surgical buttresses 500a, 500b
secured atop the respective tissue contacting surfaces 220, 320 of
staple cartridge 32 and anvil plate 302. FIGS. 4 and 5 also
illustrate an alternate embodiment wherein sutures 240 and 340 are
disposed past the distal ends of the central longitudinal slots
238, 338. More specifically, as shown in FIG. 4, distal recessed
groove 250b is disposed distally of a distal end of central
longitudinal slot 238. Similarly, as shown in FIG. 5, distal
recessed groove 350b is disposed distally of a distal end of
central longitudinal slot 338. In this embodiment, the force of end
effector assembly 16 opening after firing of staples 50 releases
the sutures 240, 340 from the respect recessed grooves 250 and thus
releases the buttress 500a, 500b from the respective tissue
contacting surfaces, 220, 320 of staple cartridge 32 and anvil
plate 302.
[0046] It is contemplated in alternate embodiments additional
retention systems of recessed grooves with sutures are positioned
along the tissue contacting surfaces. Such as a central recessed
groove (not shown) is positioned between the proximal and distal
recessed grooves of each of the tissue contacting surfaces of the
staple cartridge and anvil plate to further secure the surgical
buttresses thereto. It is further contemplated that perforations or
lines of weakening may be formed in buttresses 500a, 500b in order
for portions of buttresses 500a, 500b to tear away upon the opening
of end effector assembly 16.
[0047] During assembly the surgical buttresses 500a, 500b are
placed onto each of the tissue contacting surfaces 220, 320 of
staple cartridge assembly 200 and anvil assembly 300, respectively.
Sutures 240, 340 are then secured into respective recessed grooves
250, 350 thereby securing surgical buttresses 500a, 500b underneath
the respective sutures 240, 340 and partially within the respective
recessed groove 250, 350 of the tissue contacting surfaces 220, 320
(FIG. 7A). This allows the surgical buttresses 500a, 500b to remain
secured along the tissue contacting surfaces 220, 320. After
sutures 240, 340 are secured within the recessed groove 250, 350,
sutures may also be bonded to the staple cartridge 32 and/or anvil
plate 302 by known bonding methods such as ultrasonic welding,
laser welding, solvent bonding, or heat pressing. The sutures may
also be attached to the staple cartridge and/or anvil plate using
adhesive. In certain embodiments, the surgical buttress 500a and/or
surgical buttress 500b is attached to the staple cartridge and/or
anvil plate using bonding methods such as ultrasonic welding, laser
welding, solvent bonding, or heat pressing, or using an
adhesive.
[0048] As illustrated in FIG. 6, during use of surgical stapling
apparatus 10, the first jaw or staple cartridge assembly 200 and
the second jaw or anvil assembly 300, having surgical buttresses
500a, 500b loaded thereon (as described above) are positioned on
either side of the surgical site. Surgical buttresses 500a, 500b
positioned atop tissue contacting surfaces 220, 320 of staple
cartridge assembly 200 and anvil assembly 300 are positioned
adjacent layers of tissue "T" to be fastened to one another.
[0049] As shown in FIG. 7, staple cartridge assembly 200 includes
surgical staples 50 positioned within individual staple retaining
slots 52 of staple cartridge 32. Staples 50 are of a conventional
type and include a backspan 54 having a pair of legs 56 and 58
extending from backspan 54. Legs 56 and 58 terminate in tissue
penetrating tips 60 and 62, respectively. Pushers 64 are located
within staple retaining slots 52 and are positioned between staples
50 and the path of a drive bar 66.
[0050] In the illustrated embodiment, surgical stapling apparatus
10 is initially actuated by movement of trigger 33 relative to
handle 12 (FIG. 1) causing driver 36 to move in the direction of
arrow "A" (FIG. 6), and against sloped edge 21 of anvil plate 302
thereby causing anvil assembly 300 to be moved to the closed
position relative to staple cartridge assembly 200.
[0051] As drive bar 66 advances distally within staple cartridge
32, drive bar 66 urges pushers 64 upwardly against backspan 54 of
staples 50 driving legs 56 and 58 of staples 50 through the
cartridge buttress 500a, tissue "T", and anvil buttress 500b,
towards staple forming pockets 68 in anvil plate 302 of anvil
assembly 300. Tissue penetrating tips 60 and 62 of staple legs 56
and 58 are bent within staple forming pockets 68 in anvil plate 302
with backspan 54 securing surgical buttress 500 against tissue
"T".
[0052] Upon full actuation of surgical stapling apparatus 10, a
knife 30 (FIG. 7) associated with surgical stapling apparatus 10
and carried by driver 36 may be utilized to cut tissue "T", as well
as surgical buttresses 500a, 500b between the rows of now formed
staples 50. Upon movement of anvil assembly 300 to the open
position, spaced apart from staple cartridge assembly 200, surgical
buttresses 500a, 500b are pulled or torn away from respective
tissue contacting surfaces 220, 320 of respective staple cartridge
assembly 200 and anvil assembly 300. As detailed in FIG. 7A, anvil
buttress 500b is shown secured to tissue contacting surface 320 by
suture 340 within proximal recess 250a. In a similar manner
cartridge buttress 500a is secured to tissue contacting surface 220
by suture. As anvil assembly 300 and staple cartridge assembly 200
are pulled apart, suture 240 is released from proximal recess 250a
and thereby releases anvil buttress 500b. In embodiments, suture
240 is cut or severed by the passage of knife blade 31 of knife 30
through longitudinal slots 238, 338.
[0053] The resulting tissue "T", divided and stapled closed with
staples 50, is illustrated in FIG. 8. Specifically, surgical
buttresses 500a, 500b are secured against tissue "T" by legs 56, 58
and backspans 54 of staples 50. Thus, surgical buttresses 500a,
500b are stapled to tissue "T" thereby sealing and reinforcing the
staple lines created by staples 50.
[0054] Referring now to FIGS. 9A and 9B, an annular surgical
stapling apparatus 110, for use with surgical buttresses 124 of the
present disclosure, is shown. Surgical stapling apparatus 110
includes a handle assembly 112 having at least one pivotable
actuating handle member 133, and an advancing member 135. Extending
from handle member 112, there is provided a tubular body portion
114 which may be constructed so as to have a curved shape along its
length. The tubular body portion can be straight, curved, flexible
or have other shapes. Body portion 114 terminates in a staple
cartridge assembly 122 which includes a pair of annular arrays of
staple retaining slots 152 having a staple 150 disposed in each one
of staple retaining slots 152. Positioned distally of staple
cartridge 122 there is provided an anvil assembly 120 including an
anvil member 121 and a shaft 123 operatively associated therewith
for removably connecting anvil assembly 120 to a distal end portion
of stapling apparatus 110.
[0055] Staple cartridge assembly 122 may be fixedly connected to
the distal end of tubular body portion 114 or may be configured to
concentrically fit within the distal end of tubular body portion
114. Staple cartridge assembly 122 includes a staple pusher 164
including a proximal portion having a generally frusto-conical
shape and a distal portion defining two concentric rings of
peripherally spaced fingers (not shown), each one of which is
received within a respective staple retaining slot 152. The staple
cartridge may be configured to be removable and replaceable.
[0056] A knife 130, substantially in the form of an open cup with
the rim thereof defining a knife blade 131, is disposed within
staple cartridge assembly 122 and mounted to a distal surface of a
staple pusher 164. The knife 130 is disposed radially inward of the
pair of annular arrays of staples 150. Accordingly, in use, as the
staple pusher 164 is advanced, the knife 130 is also advanced
axially distally.
[0057] As seen in FIGS. 10A and 10B, a surgical buttress 124 is
releasably attached to the staple cartridge assembly 122 at
recessed grooves 155 defined within tissue contacting surface 134
of the staple cartridge assembly 122. It is contemplated that each
recessed groove 155 extends in a radial direction and completely
across the tissue contacting surfaces of anvil assembly 120 and
staple cartridge assembly 122. As described herein above, sutures
140 are placed within recessed grooves 155 to secure surgical
buttress 124 to tissue contacting surface 134. Surgical buttress
124 is provided in an annular configuration and includes a central
aperture 125 to receive shaft 123 of anvil assembly 120
therethrough.
[0058] It is envisioned that the surgical buttress 124 may be
additionally or alternatively attached or adhered to tissue
contacting surface of anvil plate 121 in a manner similar to the
surgical buttress 124 attached to staple cartridge assembly 122.
The buttress may be attached using bonding methods such as
ultrasonic welding, laser welding, solvent bonding, or heat
pressing. The buttress may also be attached to the staple cartridge
and/or anvil plate using adhesive. In certain embodiments, suture
is used as described above and the suture is attached using bonding
methods such as ultrasonic welding, laser welding, solvent bonding,
or heat pressing. The suture may also be attached using
adhesive.
[0059] Surgical buttress 124 may be secured or adhered to the
staple cartridge 122 by sutures 140 which extend between inner
portion or peripheral edge 160 and outer portion or peripheral edge
162 of staple cartridge 122. It is envisioned that other
configurations of placement of recessed grooves 155 and sutures 140
may be utilized to retain the surgical buttress 124 to the staple
cartridge assembly 122.
[0060] Surgical stapling apparatus 110 and detachable anvil
assembly 120 are used in an anastomosis procedure to effect joining
of intestinal sections 50 and 52. The anastomosis procedure is
typically performed using minimally invasive surgical techniques
including laparoscopic means and instrumentation. At the point in
the procedure shown in FIG. 11, a diseased intestinal section has
been previously removed, anvil assembly 120 (optionally including a
surgical buttress 124 thereon) has been applied to the operative
site either through a surgical incision or transanally and
positioned within intestinal section 52, and tubular body portion
114 of surgical stapling apparatus 110 (optionally including a
surgical buttress 124 thereon) has been inserted transanally into
intestinal section 50. Intestinal sections 50 and 52 are also shown
temporarily secured about their respective components (e.g., shaft
123 of anvil assembly 120, and the distal end of tubular body
portion 114) by conventional means such as a purse string suture
"P", as illustrated in FIG. 12.
[0061] Thereafter, the clinician maneuvers anvil assembly 120 until
the proximal end of shaft 123 is inserted into the distal end of
tubular body portion 114 of surgical stapling apparatus 110,
wherein the mounting structure (not shown) within the distal end of
tubular body portion 114 engages shaft 123 to effect the mounting.
Anvil assembly 120 and tubular body portion 114 are then
approximated to approximate intestinal sections 50, 52. Surgical
stapling apparatus 110 is then fired. A knife (not shown) cuts the
portion of tissue and surgical buttress 124 disposed radially
inward of the knife, to complete the anastomosis. The force of the
opening of anvil assembly 120 and staple cartridge assembly 122,
with surgical buttress 124 stapled to intestinal sections 50 and
52, causes sutures 140 to release from within the recessed grooves
150 thereby releasing the surgical buttress 124 from the tissue
contacting surface 134.
[0062] In further embodiments, suture is used to attach a surgical
buttress to the anvil assembly 120. Recessed grooves are provided
in the anvil plate of the anvil assembly 120 and suture engages the
surgical buttress at the grooves.
[0063] Persons skilled in the art will understand that the devices
and methods specifically described herein and illustrated in the
accompanying figures are non-limiting exemplary embodiments, and
that the description, disclosure, and figures should be construed
merely exemplary of particular embodiments. It is to be understood,
therefore, that the present disclosure is not limited to the
precise embodiments described, and that various other changes and
modifications may be effected by one skilled in the art without
departing from the scope or spirit of the disclosure. Additionally,
it is envisioned that the elements and features illustrated or
described in connection with one exemplary embodiment may be
combined with the elements and features of another exemplary
embodiment without departing from the scope of the present
disclosure, and that such modifications and variations are also
intended to be included within the scope of the present disclosure.
Accordingly, the subject matter of the present disclosure is not to
be limited by what has been particularly shown and described,
except as indicated by the appended claims.
* * * * *